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Okawa R, Nakano K. Dental manifestation and management of hypophosphatasia. JAPANESE DENTAL SCIENCE REVIEW 2022; 58:208-216. [PMID: 35814738 PMCID: PMC9260292 DOI: 10.1016/j.jdsr.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 06/22/2022] [Accepted: 06/26/2022] [Indexed: 11/24/2022] Open
Abstract
Hypophosphatasia is an inherited metabolic disorder characterized by defective mineralization of bones and teeth with a wide variety of manifestations, ranging from stillbirth to dental symptoms alone. Recently, the prognosis of severe hypophosphatasia patients has been greatly improved by the introduction of enzyme replacement therapy. The typical dental manifestation is early exfoliation of primary teeth due to disturbed cementum formation, so dentures are recommended to ensure that important oral functions are acquired. Some studies have shown that enzyme replacement therapy improves dental mineralization, resulting in the stabilization of periodontal tissues and better growth of tooth roots. A nationwide Japanese survey revealed the common genetic and dental manifestations of patients with mild hypophosphatasia, which markedly differ from those of the severe forms. There may be many undiagnosed mild patients, so dentists should contribute to the early diagnosis by screening possible cases based on the typical finding of early exfoliation of primary teeth. Early diagnosis is important for patients to receive early intervention in both medical and dental fields. The establishment of fundamental dental therapy to solve the dental problems is still underway and is eagerly anticipated.
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Siami H, Parsamanesh N, Besharati Kivi S. Young woman with hypophosphatasia: A case report. Clin Case Rep 2022; 10:e05633. [PMID: 35356190 PMCID: PMC8958189 DOI: 10.1002/ccr3.5633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 02/23/2022] [Accepted: 03/09/2022] [Indexed: 11/11/2022] Open
Abstract
Hypophosphatasia is a rare inherited disease defined by teeth and bone mineralization impairment leading to depletion of tissue non‐specific alkaline phosphatase. We define a young woman diagnosed with hypophosphatasia (after several times alkaline phosphatase levels were low) was discovered following femoral fracture. A 30‐year‐old woman who presented for a history of early permanent teeth loss during the last 5 years and HPP‐like symptoms in family history and bone radiograph verified bowing, deficient mineralization, and symmetrical subtrochanteric stress fractures of femurs was referred to our clinic for further management. Blood test findings defined raised phosphorus levels on two occasions at 6.2 and 5.7 mg/dl and insufficient 25‐hydroxy vitamin D level. HPP early diagnosis and adequate treatment, depending on the clinical symptoms along with laboratory tests, could be effective in decreasing the suffering of the disease and side effects.
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Affiliation(s)
- Haleh Siami
- School of Medicine Islamic Azad University of Medical Science Tehran Iran
| | - Negin Parsamanesh
- Zanjan Metabolic Diseases Research Center Zanjan University of Medical Science Zanjan Iran
| | - Shahin Besharati Kivi
- Zanjan Metabolic Diseases Research Center Zanjan University of Medical Science Zanjan Iran
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Lü KL, Xie SS, Tang ZY, Liu E, Luo XG, Xiong Q, Wang B, Fan QL, Wu ZF, Zhang YP. Dynamic trend in alkaline phosphatase activity in infants aged 0-12 months revealed by an indirect approach. Clin Biochem 2021; 100:48-54. [PMID: 34852256 DOI: 10.1016/j.clinbiochem.2021.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 11/18/2021] [Accepted: 11/24/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Alkaline phosphatase (ALP) is a ubiquitous enzyme in humans that can be used for diagnosing childhood diseases. Infants have the highest rapid growth rate and are susceptible to metabolic bone diseases. In infants, ALP activities exhibit significant month-wise variations, and authoritative standards are lacking. The present study aimed to provide a reference for the diagnosis of diseases related to abnormal ALP activities in infants. METHODS This study included 24,618 samples collected from infants aged 0-12 months from three medical centers in Chongqing, China. Samples of infants diagnosed with diseases that may affect ALP activity have been exclude. ALP activity was analyzed using an automatic biochemical analyzer. A percentile curve for ALP activity in male and female infants was constructed using MATLAB, and the skewness-median-coefficient of variation method was employed for curve fitting. RESULTS ALP activity in male and female infants peaked at 0-4 months; the peak appeared at 1-2 months and declined gradually thereafter. After 4-5 months of age, the ALP activities declined further, with the lowest values observed at 11-12 months of age. A comparison between the data from this study and a those from a published German study indicates that Chinese infants exhibited peak ALP activity later and subsequent decline greater than German infants. CONCLUSIONS A percentile curve was constructed for month-wise ALP activity in male and female infants, which could provide a reference for diagnosing diseases related to abnormal ALP activity in infants.
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Affiliation(s)
- Kui-Lin Lü
- Department of Pediatrics, Xinqiao Hospital, Third Military Medical University (Army Medical University), Chongqing 400037, PR China
| | - Shuang-Shuang Xie
- Department of Hematology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, PR China
| | - Zi-Yun Tang
- Information Section, Xinqiao Hospital, Third Military Medical University (Army Medical University), Chongqing 400037, PR China
| | - En Liu
- Department of Gastroenterology, Xinqiao Hospital, Third Military Medical University (Army Medical University), Chongqing 400037, PR China
| | - Xiao-Ge Luo
- Department of Clinical Laboratory, Xinqiao Hospital, Third Military Medical University (Army Medical University), Chongqing 400037, PR China
| | - Qi Xiong
- Department of Clinical Laboratory, Xinqiao Hospital, Third Military Medical University (Army Medical University), Chongqing 400037, PR China
| | - Bo Wang
- Department of Clinical Laboratory, Daping Hospital, Third Military Medical University (Army Medical University), Chongqing 400042, PR China
| | - Qiong-Li Fan
- Department of Pediatrics, Xinqiao Hospital, Third Military Medical University (Army Medical University), Chongqing 400037, PR China
| | - Zhi-Feng Wu
- Department of Pediatrics, Xinqiao Hospital, Third Military Medical University (Army Medical University), Chongqing 400037, PR China.
| | - Yu-Ping Zhang
- Department of Pediatrics, Xinqiao Hospital, Third Military Medical University (Army Medical University), Chongqing 400037, PR China.
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Karakostas P, Dolscheid-Pommerich R, Hass MD, Weber N, Brossart P, Schäfer VS. [Prevalence of hypophosphatasia in adult patients in rheumatology]. Z Rheumatol 2021; 81:513-519. [PMID: 33852075 PMCID: PMC9338116 DOI: 10.1007/s00393-021-00994-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2021] [Indexed: 11/29/2022]
Abstract
Hintergrund Die Hypophosphatasie (HPP) ist eine genetische Erkrankung, die durch eine oder mehrere Mutationen im Gen für alkalische Phosphatase (ALP) verursacht wird, verantwortlich für die Kodierung der gewebespezifischen ALP und für den Mineralisierungsprozess. Ziel der Arbeit Bestimmung der Prävalenz der HPP bei rheumatologischen Patienten. Material und Methoden Retrospektive Analyse der Krankenakten aller erwachsener Patienten mit pathologisch erniedrigten gesamt ALP-Werten (<35 U/l), die zwischen Januar 2017 und Juni 2019 in der Rheumatologie der Medizinischen Klinik III am Universitätsklinikum Bonn behandelt wurden. Die Analyse wurde in Bezug auf klinische Zeichen sowie auf die Ergebnisse der Gentests für HPP untersucht. Ergebnisse Bei 60 von 2289 Patienten (2,62 %) zeigten sich pathologisch niedrige ALP-Werte, bei 30 von ihnen (1,31 %) wurden persistierend niedrige ALP-Werte festgestellt. Bei 19 dieser 30 Patienten wurde ein Gentest für ALP-Genmutationen durchgeführt. Sieben der 19 Patienten (36,84 %) hatten HPP-Zeichen (Insuffizienzfrakturen oder schlechter Zahnstatus seit der Kindheit), alle mit pathologischer ALP-Mutation. Drei dieser Patienten (15,78 %) hatten jeweils eine Insuffizienzfraktur mit normwertiger Knochendichtemessung in der Vorgeschichte. Insgesamt 13 von 19 Patienten wiesen (68,42 %) Mutationen im ALP-Gen auf. Interessanterweise wurde keine Assoziation mit einer Chondrokalzinose festgestellt. Diskussion Die HPP scheint eine unterdiagnostizierte Erkrankung mit einem höheren Anteil betroffener Patienten, welche in der Rheumatologie vorstellig werden, zu sein. Daher sollten zukünftige Studien darauf abzielen, ein Diagnostikprotokoll in der klinischen Praxis zu entwickeln.
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Affiliation(s)
- P Karakostas
- Klinik für Innere Medizin III, Onkologie, Hämatologie, Rheumatologie und Klinische Immunologie, Universitätsklinikum Bonn, Venusberg Campus 1, 53127, Bonn, Deutschland.
| | - R Dolscheid-Pommerich
- Institut für Klinische Chemie und Klinische Pharmakologie, Universitätsklinikum Bonn, Bonn, Deutschland
| | - M D Hass
- Zentrum für Blutgerinnungsstörungen und Transfusionsmedizin Bonn, Bonn, Deutschland
| | - N Weber
- Klinik für Innere Medizin III, Onkologie, Hämatologie, Rheumatologie und Klinische Immunologie, Universitätsklinikum Bonn, Venusberg Campus 1, 53127, Bonn, Deutschland
| | - P Brossart
- Klinik für Innere Medizin III, Onkologie, Hämatologie, Rheumatologie und Klinische Immunologie, Universitätsklinikum Bonn, Venusberg Campus 1, 53127, Bonn, Deutschland
| | - V S Schäfer
- Klinik für Innere Medizin III, Onkologie, Hämatologie, Rheumatologie und Klinische Immunologie, Universitätsklinikum Bonn, Venusberg Campus 1, 53127, Bonn, Deutschland
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Age-wise trends in alkaline phosphatase activity in 167,625 Chinese children aged 0-18 years. Clin Biochem 2020; 79:34-40. [PMID: 32142736 DOI: 10.1016/j.clinbiochem.2020.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 02/26/2020] [Accepted: 03/01/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Alkaline phosphatase (ALP) serves as a biomarker for diagnosing several types of diseases in adults; nonetheless, its use is restricted in children because of changes in ALP activity during different physiological phases. The present study aimed to investigate ALP activity and its dynamics in children of different ages to establish the reference values for ALP activity in children. METHODS Total 167,625 samples of children aged 0-18 years were enrolled in this study. ALP activity was measured using the 4-nitrophenyl-1-phosphate disodium salt (4-NPP)-2-amino-2-methyl-1-propanol (AMP) method with an automatic biochemical analyzer. Patients with known diagnoses that may affect ALP activity were excluded. A percentile curve was plotted using MATLAB software, and the curve was fitted using the skewness-median-coefficient of variation (LMS) method. RESULTS ALP activity reached the highest peak at 12-13 years of age and then gradually decreased to the lowest peak at 18-19 years of age in boys, whereas it reached the highest at 10-11 years and then gradually reduced to the lowest at 17-18 years in girls. Furthermore, the highest peak of ALP activity appeared substantially earlier in children of either sex in China than in those in Germany. CONCLUSIONS We showed the dynamics of ALP activity in both boys and girls between the ages of 0 and 18 years in China and compared the difference in ALP activity between children in China and Germany. Our findings provide a reference for clinicians.
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Bhadada SK, Pal R, Dhiman V, Alonso N, Ralston SH, Kaur S, Gupta R. Adult hypophosphatasia with a novel ALPL mutation: Report of an Indian kindred. Bone Rep 2020; 12:100247. [PMID: 32025537 PMCID: PMC6997823 DOI: 10.1016/j.bonr.2020.100247] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 01/03/2020] [Accepted: 01/21/2020] [Indexed: 01/25/2023] Open
Abstract
Hypophosphatasia is an inborn error in metabolism characterized by low serum alkaline phosphatase (ALP) activity resulting from deactivating mutations in TNSALP (also known as ALPL), the gene that encodes the ‘tissue-specific’ isoenzyme of ALP. The disease exhibits significant clinical heterogeneity that spans from death in utero to only dental complications in adult life. Herein, we report a 47-year-old woman presenting with fracture of shaft of left femur. She had been complaining of pain in both of her thighs for the past 3 years. In addition, she gave a history of premature loss of teeth. Review of old radiographs revealed pseudo-fractures involving the lateral cortices of the femora on both sides. Biochemical panel revealed hyperphosphatemia, persistently low total alkaline phosphatase (ALP) and low-normal bone turnover markers. Screening of her siblings revealed low ALP in her younger sister and brother who were otherwise free from any major dento-arthro-osseous complaints. Sanger sequencing showed a novel, heterozygous, missense mutation in exon 5 at position 311 (c.311a > g;p.104 Asn > Ser) of ALPL gene in the three members. The patient underwent open reduction and intramedullary nailing of left femur along with prophylactic nailing on right side. This case report represents the first genetically confirmed kindred of adult hypophosphatasia from the Indian subcontinent.
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Affiliation(s)
- Sanjay K Bhadada
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh, India-160012
| | - Rimesh Pal
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh, India-160012
| | - Vandana Dhiman
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh, India-160012
| | - Nerea Alonso
- Rheumatology and Bone Disease Unit, Centre for Genomic and Experimental Medicine, IGMM, University of Edinburgh, Western General Hospital, Crewe Road, Edinburgh, EH4 2XU
| | - Stuart H Ralston
- Rheumatology and Bone Disease Unit, Centre for Genomic and Experimental Medicine, IGMM, University of Edinburgh, Western General Hospital, Crewe Road, Edinburgh, EH4 2XU
| | - Simran Kaur
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh, India-160012
| | - Rajat Gupta
- Department of Diabetes and Endocrinology, Alchemist Hospital, Panchkula 134112, India
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García-Fontana C, Villa-Suárez JM, Andújar-Vera F, González-Salvatierra S, Martínez-Navajas G, Real PJ, Gómez Vida JM, de Haro T, García-Fontana B, Muñoz-Torres M. Epidemiological, Clinical and Genetic Study of Hypophosphatasia in A Spanish Population: Identification of Two Novel Mutations in The Alpl Gene. Sci Rep 2019; 9:9569. [PMID: 31267001 PMCID: PMC6606844 DOI: 10.1038/s41598-019-46004-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 06/18/2019] [Indexed: 12/13/2022] Open
Abstract
Hypophosphatasia (HPP) is a genetic disease caused by one or several mutations in ALPL gene encoding the tissue-nonspecific alkaline phosphatase affecting the mineralization process. Due to its low prevalence and lack of recognition, this metabolic disorder is generally confused with other more frequent bone disorders. An assessment of serum total alkaline phosphatase (ALP) levels was performed in 78,590 subjects. Pyridoxal-5′-phosphate (PLP) concentrations were determined and ALPL gene was sequenced in patients potentially affected by HPP. Functional validation of the novel mutations found was performed using a cell-based assay. Our results showed persistently low serum ALP levels in 0.12% of subjects. Among the studied subjects, 40% presented with HPP-related symptoms. Nine of them (~28%) had a history of fractures, 5 (~16%) subjects showed chondrocalcinosis and 4 (~13%) subjects presented with dental abnormalities. Eleven subjects showed increased PLP concentrations. Seven of them showed ALPL gene mutations (2 of the mutations corresponded to novel genetic variants). In summary, we identified two novel ALPL gene mutations associated with adult HPP. Using this protocol, almost half of the studied patients were diagnosed with HPP. Based on these results, the estimated prevalence of mild HPP in Spain could be up to double than previously reported.
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Affiliation(s)
- Cristina García-Fontana
- University Hospital San Cecilio, Instituto de Investigación Biosanitaria (Ibs.GRANADA), Granada, Spain.,Fundación para la Investigación Biosanitaria de Andalucía Oriental (FIBAO), Granada, Spain
| | - Juan M Villa-Suárez
- Clinical Analysis Unit, University Hospital San Cecilio, Granada, Spain.,Department of Medicine, University of Granada, Granada, Spain
| | - Francisco Andújar-Vera
- University Hospital San Cecilio, Instituto de Investigación Biosanitaria (Ibs.GRANADA), Granada, Spain.,Fundación para la Investigación Biosanitaria de Andalucía Oriental (FIBAO), Granada, Spain
| | - Sheila González-Salvatierra
- University Hospital San Cecilio, Instituto de Investigación Biosanitaria (Ibs.GRANADA), Granada, Spain.,Fundación para la Investigación Biosanitaria de Andalucía Oriental (FIBAO), Granada, Spain.,Department of Medicine, University of Granada, Granada, Spain
| | - Gonzalo Martínez-Navajas
- Gene Regulation, Stem Cells & Development Lab, GENYO, Centre for Genomics and Oncological Research: Pfizer-University of Granada-Andalusian Regional Government, Granada, Spain.,Department of Biochemistry and Molecular Biology I, University of Granada, Granada, Spain
| | - Pedro J Real
- Gene Regulation, Stem Cells & Development Lab, GENYO, Centre for Genomics and Oncological Research: Pfizer-University of Granada-Andalusian Regional Government, Granada, Spain.,Department of Biochemistry and Molecular Biology I, University of Granada, Granada, Spain
| | | | - Tomás de Haro
- Clinical Analysis Unit, University Hospital San Cecilio, Granada, Spain
| | - Beatriz García-Fontana
- University Hospital San Cecilio, Instituto de Investigación Biosanitaria (Ibs.GRANADA), Granada, Spain. .,CIBERFES, Instituto de Salud Carlos III, Granada, Spain.
| | - Manuel Muñoz-Torres
- University Hospital San Cecilio, Instituto de Investigación Biosanitaria (Ibs.GRANADA), Granada, Spain.,Department of Medicine, University of Granada, Granada, Spain.,CIBERFES, Instituto de Salud Carlos III, Granada, Spain.,Endocrinology and Nutrition Unit, University Hospital San Cecilio, Granada, Spain
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